Metástasis ganglionar mesentérica de neoplasia neuroendocrina: una causa infrecuente de obstrucción de intestino delgado / Small bowel obstruction caused by lymph nodes of a neuroendocrine tumor: a clinical case report

Small intestine neuroendocrine tumors (NET-SI) are relatively rare neoplasms. If encountered, the most common location is the ileum. Symptoms are usually non-specific, delaying the tumors diagnosis. NET-SI are often small in size and can be challenging to recognize on imaging studies. However, they have a tendency to induce a pronounced fibrotic reaction in the mesentery, often accompanied by large calcified mesenteric adenopathies. In some cases, the fibrotic reaction can produce rare complications, such as intestinal obstruction or vascular congestion with occasional secondary ischemia. This case report presents a 79-year-old male with a partial small bowel obstruction caused by a fibrotic reaction and mesenteric adenopathies of a well-differentiated neuroendocrine tumor of the ileum. The patient also presented multiple peritoneal metastases at diagnosis. Characteristic imaging findings of the tumor, allowed an accurate and early diagnosis. Once the acute episode was resolved, the diagnosis was confirmed with an image guided biopsy.

Endometriosis con infiltración aislada del nervio ciático, una forma de presentación atípica: reporte de un caso clínico / Isolated infiltrative endometriosis of the sciatic nerve, an atypical presentation: clinical case report

INTRODUCCIÓN: La endometriosis afecta hasta un 10-15% de las mujeres jóvenes. Se define como tejido endometrial funcional fuera de la cavidad uterina y su presentación clásica es la dismenorrea. La variedad profunda afecta a un 1-2% y las localizaciones más frecuentes son el peritoneo pélvico, ovarios, ligamentos útero-sacros y septum recto-vaginal; sin embargo, puede presentarse de forma muy infrecuente como implantes aislados localizados en relación al nervio ciático. El diagnóstico habitualmente es complejo y tardío, dado que los síntomas son inespecíficos y el examen físico puede ser indistinguible de otras etiologías. El estudio imagenológico de elección para la endometriosis profunda es la resonancia magnética (RM) de pelvis ya que una adecuada localización pre-quirúrgica de las lesiones es fundamental. CASO CLÍNICO: Paciente de sexo femenino de 46 años, con tres años de dolor pélvico, dismenorrea y dispareunia. El síntoma cardinal fue dolor ciático progresivo, con déficit motor y alteraciones sensitivas, los cuales se exacerbaban durante la menstruación y no presentaban respuesta al tratamiento farmacológico. En la RM se identifica nódulo sólido sospechoso de endometriosis en relación al nervio ciático derecho. El caso es evaluado por un comité multidisciplinario y se realiza cirugía laparoscópica. El diagnóstico de sospecha es confirmado histológicamente. La paciente presenta buena recuperación post-quirúrgica y cese completo de los síntomas descritos. DISCUSIÓN: La endometriosis profunda presenta un reto diagnóstico y habitualmente es tardío. Este caso presenta el resultado exitoso de una buena sospecha clínica, un estudio imagenológico completo y la resolución con una técnica quirúrgica compleja.

INTRODUCTION: Endometriosis is a disease that affects 10-15% of young women. It is characterized as functional endometrial tissue outside the uterine cavity. The most common form of presentation is dysmenorrhea. Deep endometriosis affects 1-2% of the patients, and is frequently located in the pelvic peritoneum, ovaries, utero-sacral ligaments and recto-vaginal septum. The isolated endometriosis of the sciatic nerve is a very uncommon presentation of this disease. Late diagnosis is frequent, mainly because the symptoms are non-specific, and the physical examination may be indistinguishable from other etiologies. The imaging study of choice is the pelvic magnetic resonance imaging (MRI) and an accurate pre-surgical location of the lesions is critical for a successful surgical outcome. CLINICAL CASE: 46-year-old female patient with 3 years of pelvic pain, dysmenorrhea and dyspareunia. The cardinal symptom was progressive sciatic pain, with motor deficit and sensory alterations. The pain was persistent despite pharmacological treatment and exacerbated during menstruation. MRI identifies a nodule located in the pelvic portion of the right sciatic nerve, suggestive of an endometriosis implant. The case was discussed by a multidisciplinary committee and laparoscopic surgery was performed. The diagnosis was confirmed with histology. The patient recovered well from surgery with significant improvement of the previously described symptoms. DISCUSSION: The diagnosis of deep endometriosis is challenging and usually delayed. This rare disease had a successful outcome, due to an early clinical suspicion, a thorough imaging study and an effective resolution with a complex surgical technique.

Cirugía Robótica en cáncer de vejiga músculo-invasor, una interrogante aún sin resolver / Robotic Surgery In Muscle-Invasive Bladder Cancer, An Unresolved Interrogant

INTRODUCCIÓN: La cirugía robótica es una técnica en aumento tanto en Chile como en el mundo. Una de las áreas de la medicina que ha sido pionera en la introducción de esta nueva técnica es Urología, dónde ha crecido el interés en torno a la utilización de la cirugía robótica en cáncer de vejiga músculo invasor(CVMI). El objetivo de esta revisión es examinar la bibliografía disponible sobre el tema. MÉTODOS: Se realizó una búsqueda no sistemática de la literatura utilizando la base de datos de Pubmed y MGH Treadwell library. En estas se utilizaron las palabras claves "Bladder cancer", Muscle-invasive bladder cancer", "Blader cancer epidemiology" , "Radical cistectomy" "Robot-assisted radical cistectomy", ¨Robotic surgery urology¨. Se aplicaron límites de publicaciones dentro de los últimos 10 años. DISCUSIÓN: El cáncer vesical es una enfermedad de alta prevalencia, aproximadamente el 25 % de ellos se presentan con CVMI al momento del diagnóstico. El tratamiento de estándar actualmente para CVMI la cistectomía radical con linfadenectomía pélvica extendida, derivación urinaria y quimioterapia neoadyuvante en ciertos casos. Buscando dar solución a las complicaciones de esta cirugía, surge el interés por utilizar la cirugía robótica en el tratamiento de CVMI a través de la cistectomía radical asistida por robot(CRAR). Actualmente se han publicado estudios con resultados que indican disminución de la morbilidad perioperatoria y menor estadía hospitalaria, manteniendo la eficacia oncológica de este procedimiento versus la cistectomía radical abierta(CRA). Otros estudios no han encontrado diferencias significativas entre las dos técnicas en cuanto a complicaciones. CONCLUSIÓN: Aún existe insuficiente experiencia y evidencia del uso de esta en cáncer de vejiga músculo-invasor pero los resultados actuales tienden a resultados no inferiores y positivos en cuanto a la CRAR versus la CRA.AU

METHODS: We performed a non-systematic literature search using the Pubmed and MGH Treadwell library database. Key words "Bladder cancer", Muscle-invasive bladder cancer", "Bladder cancer epidemiology" , "Radical cystectomy" "Robot-assisted radical cystectomy", ¨Robotic surgery urology¨. were used. Limits of publications were applied within the last 10 years. DISCUSSION: Bladder cancer is a highly prevalent disease. Approximately 25% of patients present with MIBC at the time of diagnosis. The standard treatment currently for CVMI is radical cystectomy with extended pelvic lymphadenectomy, urinary diversion and neoadjuvant chemotherapy in certain cases. In order to solve the complications of this surgery, there is an interest in the use of robotic surgery in the treatment of MIBC through robot assisted radical cystectomy (RARC). Studies with results indicating decreased perioperative morbidity and shorter hospital stay have been published, maintaining the oncological efficacy of this procedure versus open radical cystectomy (ORC). Other studies have found no significant difference between the two techniques in terms of complications. CONCLUSION: There is still insufficient experience and evidence of its use in m

Autopsia psicològica: una herrramienta ùtil en la caracterizaciòn del suicidio / Psychological autopsy: a useful tool in the characterization of suicide

El suicidio genera gran impacto en la vida de las personas y en la sociedad, ya que la persona fallecida deja huellas de su emocionalidad en el entorno; muchas de estas son altamente subjetivas y complejas de determinar. Para comprender el fenómeno y todo lo que rodea al suicida hasta llevarlo a tomar la decisión, se utiliza una herramienta práctica como la autopsia psicológica, actualmente usada en diversos países ya que brinda una nueva perspectiva en la patología forense y en la criminalística,elaborando una reconstrucción retrospectiva de la vida de la persona fallecida, sus patrones de conducta, personalidad, y más específicamente el estado mental previo, para así poder definir la causa y manera de muerte, tratar de descifrar la motivación de la misma, puesto que en la mayoría de los casos es de una causa dudosa u equívoca.La autopsia psicológica es de gran utilidad porque aporta información para crear perfiles suicidas que ayudan a la detección precoz de factores de riesgo y de esta manera disminuir las muertes por esta causa.La presente revisión de tema tiene por objetivo mostrar la utilidad de la autopsia psicológica en diversos campos para así incrementar su uso, rectificar o cambiar la calificación de la escena y esclarecer las circunstancias de muerte...(AU)

Suicide generates a huge impact on the lives of people and society, because the deceased person leaves traces of emotionality in the environment; many of those traces are highly subjective and complex to determine. Psychological Autopsy is a tool that allows understanding the suicide phenomenon and everything surrounding it, starting on the process of making the decision until suicide.This tool is currently used in many countries for providing a new perspective on forensic pathology and forensic science, also helps to develop a retrospective of the life of the deceased, their patterns of behavior, personality, and more specifically prior mental state, in order to define the cause and manner of death, trying to decipher the reasons for the suicide that in most on the cases are doubtful or completely wrong. That is why the Psychological autopsy is veryuseful, because it provides information in order to create suicide profiles, that in the future will help in the early detection of risk factors and reduce deaths from suicide.This topic review has as an objective to show the usefulness of Psychological Autopsy in different fields, in order to increase its use, modify or change the rate on the scene and clarify the death circumstances...(AU)

Impact of water potential on growth and germination of Fusarium solani soilborne pathogen of peanut

Studies were conducted to determine the effect of osmotic and matric stress on germination and growth of two Fusarium solani strains, the etiological agent responsible of peanut brown root rot. Both strains had similar osmotic and matric potential ranges that allowed growth, being the latter one narrower. F. solani showed the ability to grow down to -14 MPa at 25 °C in non-ionic modified osmotic medium, while under matric stress this was limited to -8.4 MPa at 25 °C. However, both strains were seen to respond differently to decreasing osmotic and matric potentials, during early stages of germination. One strain (RC 338) showed to be more sensitive to matric than osmotic (non ionic) and the other one (RC 386) showed to be more sensitive to osmotic than matric imposed water stress. After 24 h of incubation, both isolates behaved similarly. The minimum water potential for germination was -8.4 MPa on glycerol amended media and -5.6 MPa for NaCl and PEG amended media, respectively. The knowledge of the water potential range which allow mycelia growth and spore germination of F. solani provides an inside to the likely behaviour of this devastating soilborne plant pathogen in nature and has important practical implications.